Rescue scene video transmission

ABSTRACT

A defibrillator or monitoring system may comprise a defibrillator, at least one video camera configured to acquire a video of a subject being treated by the defibrillator, a data collection unit configured to collect data associated with the subject, a communications unit configured to establish a communication channel between the defibrillator system and an emergency response center; and a processing unit configured to cause transmission to the emergency response center of at least one of the video of the subject and the data associated with the subject.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation under 35 U.S. C. §120 of U.S. patentapplication Ser. No. 13/538,031, filed on Jun. 29, 2012. All subjectmatter set forth in the above referenced application is herebyincorporated by reference in its entirety into the present applicationas if fully set forth herein.

TECHNICAL FIELD

This disclosure relates to systems and techniques for rescue scene videocommunication, e.g., for a rescue scene in which a defibrillating deviceis used to treat a subject.

BACKGROUND

Sudden health problems such as sudden cardiac arrest and injuries causedby accidents kill thousands of people and cause permanent injury everyyear. Fast and competent care to resuscitate such subjects of theseproblems can be essential to positive outcomes in such situations. Forexample, it is said that the chance of surviving a sudden cardiac arrestfalls by ten percent for every minute of delay in providing effectivetreatment.

Resuscitation treatments for patients suffering from cardiac arrestgenerally include clearing and opening the patient's airway, providingrescue breathing for the patient, and applying chest compressions toprovide blood flow to the subject's heart, brain, and other vitalorgans. If the patient has a shockable heart rhythm (ventricularfibrillation or pulseless ventricular tachycardia), resuscitation alsomay include defibrillation therapy. Along with such action, anelectrocardiogram (ECG) signal for the patient may be electronicallycaptured, displayed, and monitored, so that rescuers can determine whenthe patient's heart has returned to normal or near-normal operation, anddetermine when the heart exhibits a shockable rhythm. About half ofpatients who suffer ventricular fibrillation (VF) have a recurrence ofVF within minutes of successful VF conversion, which may then requirereconversion. Patient odds of survival fall with repeated VF recurrenceduring resuscitation.

SUMMARY

Described herein are systems and techniques for transmitting and/orreceiving video and/or audio communication between a rescue scene and anemergency response center. More particularly, one or more video camerasare included with a defibrillator, such as an automated externaldefibrillator (AED). When a subject (e.g., a victim of cardiac arrest)receives treatment from a caregiver with the assistance of the AED, thecameras acquire still and/or video images of the subject, the caregiver,and/or the rescue scene.

In some examples, a responder can select one or more cameras and/ormicrophones from which to receive video/audio transmission. For example,a still image acquired by each of the cameras is transmitted to theemergency response center, where a responder (e.g., a dispatcher)selects one or more of the images as representing a view for which hewould like to receive a streaming video transmission. Video and/or audiofrom the camera(s)/microphones corresponding to the selected image(s) istransmitted in real-time to the emergency response center, enabling theresponder to assess the situation at the rescue scene and/or provideguidance and instructions to the caregiver.

In some additional examples, if the bandwidth of the communicationchannel between the rescue scene and the emergency response center islimited, the transmission of the video and/or audio may be limited orstopped in order to allow preferential transmission of otherinformation, such as subject monitoring data and/or audio conversations.

The systems and techniques described herein have a number of advantages.For instance, providing real-time video/audio of a rescue scene and/or asubject receiving treatment to a responder at an emergency responsecenter enables the responder to assess the urgency of the situation atthe rescue scene and react accordingly, e.g., by dispatching theappropriate first responders. In addition, by receiving the video and/oraudio transmission, the responder may be able to guide a caregiver inthe treatment of the subject and/or the operation of equipment (e.g., anautomated external defibrillator (AED)) used to treat the subject.Furthermore, with multiple cameras and/or microphones associated withrescue equipment, there is a reasonable likelihood that at least one ofthe cameras and/or microphones will be positioned so as to capture therescue scene, thus allowing the rescuer to focus on treatment of thesubject without having to spend time setting up or adjusting a camera.

The details of one or more embodiments are set forth in the accompanyingdrawings and the description below. Other features and advantages willbe apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a schematic diagram of a rescue scene and an emergencyresponse center.

FIG. 2 is a block diagram of an example defibrillating system.

FIG. 3 is a flow chart of an example process for camera selection.

FIG. 4 is a schematic diagram of an example user interface.

FIG. 5 is a flow chart of an example process for video and datatransmission.

DETAILED DESCRIPTION

Described herein are systems and techniques for video and/or audiobidirectional communication between a rescue scene and an emergencyresponse center. More particularly, one or more video cameras and/ormicrophones are included with a defibrillator, such as an automatedexternal defibrillator (AED) When a subject (e.g., a victim of cardiacarrest) receives treatment from a caregiver with the assistance of theAED, the cameras acquire still and/or video images of the subject, thecaregiver, and/or the rescue scene. A still image acquired by each ofthe cameras is transmitted to the emergency response center, where aresponder (e.g., a dispatcher) selects one or more of the images asrepresenting a view for which he would like to receive a streaming videotransmission. Video from the camera(s) corresponding to the selectedimage(s) and/or audio is communicated in real-time between emergencyresponse center and the rescue scene, enabling the responder to assessthe situation at the rescue scene and/or provide guidance andinstructions to the caregiver. If the bandwidth of the communicationchannel between the rescue scene and the emergency response center islimited, the transmission of the video and/or audio may be limited orstopped in order to allow preferential transmission of otherinformation, such as subject monitoring data and/or audio conversations.

Referring to FIG. 1, at a rescue scene 100, a caregiver 104 performscardiopulmonary resuscitation (CPR) on a subject 102. An electronicdefibrillating and/or monitoring system 106 including a defibrillator,such as an automated external defibrillator (AED) 108, a professionaldefibrillator, or another type of defibrillating apparatus, instructsthe caregiver 104 in performing CPR and provides defibrillation asneeded via external electrode pads 110. The subject may be, forinstance, an individual who has apparently undergone sudden cardiacarrest. The caregiver may be, for instance, a civilian responder withlimited or no training in lifesaving techniques; a first responder, suchas an emergency medical technician (EMT), police officer, orfirefighter; or a medical professional, such as a physician or nurse.The caregiver 104 may be acting alone or may be acting with assistancefrom one or more other caregivers, such as a partner EMT.

One or more video cameras, such as video cameras 105 and 107, areprovided with the defibrillating system 106. The cameras 105, 107 arepositioned to acquire still images and/or video images of variousportions of the rescue scene 100, such as an image of a large part ofthe rescue scene 100, an image of the subject 102, an image of thecaregiver's treatment of the subject, or another view. For instance, acamera (in this example, camera 105) may be mounted on a headpiece 109or other wearable item that is to be worn by the caregiver 104, e.g., toprovide a view of the caregiver's treatment of the subject. Anothercamera (in this example, camera 107) may be mounted on the AED 108,e.g., to provide a broad view of a large part of the rescue scene 100.Further, one or more cameras (e.g., camera 111) may be coupled orembedded with one or more electrodes such as electrode 110. Additionalcameras may also be provided for positioning in other locations. Forinstance, a mobile (e.g., handheld) camera may be provided that can beheld and operated by another caregiver or a bystander. A camera such ascameras 105 and 107 may include an embedded microphone configured toreceive audio emanating from the rescue scene.

The defibrillating system 106 is connected via a communication channel112 to an emergency response center 116, such as a 911 call center, apolice dispatch, an ambulance dispatch, a fire department, or anotheremergency response center. In the illustrated example, the communicationchannel 112 is a long-range wireless communication channel (e.g., a 3Gor 4G communication channel) supported by a wireless transmission tower114, such as a cellular telephone tower. In other embodiments, thecommunication channel 112 may be a short-range wireless communicationchannel, such as a Bluetooth or WiFi connection, that is connected to ahardwired communication channel.

Images and/or video and audio from one or more of the cameras and/ormicrophones are communicated via the communication channel 112 betweenthe emergency response center 116 and the rescue scene 100. The imagesand/or video are displayed on a display 118 (e.g., a computer monitor,television, mobile communication device, or other display) at theemergency response center 116, enabling a responder 120 (e.g., adispatcher) to view the rescue scene 100 in real time. In someembodiments, the responder 120 may choose to receive video and/or audiofrom fewer than all of the cameras and/or microphones (e.g., from onlyone camera). For instance, the responder 120 may choose to view videofrom the camera that provides a desired view, such as a view of thesubject 102 or a broad view of a large portion of the rescue scene 100.

In an embodiment, the defibrillating system 106 also monitors thesubject 102 during treatment and collects real-time subject monitoringdata. For instance, signals such as an ECG waveform, an SpO2 level, ablood pressure, a measure of cardiac output, or a measure of heart ratemay be monitored. Alternatively or additionally, compression parameters,such as a sternal motion signal, a compression rate, a compressiondepth, or another measurement of compression, may be monitored. Some orall of these types of subject monitoring data may be transmitted to theemergency response center 116 via the communication channel 112. In someembodiments, the responder 120 may choose to view only some of the typesof subject monitoring data.

In an embodiment, audio communication is also provided between therescue scene 100 and the emergency response center 116. For instance,the defibrillating system 106 may include an audio device 122 includinga microphone and speakers, which may be integrated into one or more ofthe cameras or may be a separate device (as shown in the illustratedexample). Audio detected by the microphone in the audio device 122(e.g., a conversion between the caregiver 104 and the subject 102 orbetween the caregiver 104 and another caregiver or bystander, orquestions or comments from a caregiver to the responder 120) istransmitted to the emergency response center via the communicationchannel 112. Audio from the emergency response center 116 (e.g.,questions or instructions by the responder 120) is transmitted to thedefibrillating system 106 via the communication channel and played onthe speakers in the audio device 122. For instance, while watching thestreaming video, the responder 120 may be able to instruct the caregiver104 in treatment of the subject 102, such as how to open a pouchcontaining electrodes, how to place electrodes and/or sensors on thesubject, and how to perform CPR and/or other rescue operations. Inaddition, the responder 120 may be able to guide the caregiver inoperation of the AED system 106, such as switching the language of theAED system, switching the AED system to or from adult or pediatric mode,and/or other system operations. In some instances, the responder 120 maybe able to perform some AED system operations remotely on behalf of thecaregiver.

FIG. 2 is a block diagram of an example defibrillating system 200 forproviding CPR and defibrillation assistance to a caregiver 238administering care to a subject 202 and for communicating with anemergency response center 206. In general, the system 200 includes anumber of medical devices that may be used to provide life-saving careto subject 202. The devices may be part of a single unit or multipleunits, and may be used to monitor various real-time physical parametersof the subject 202, to communicate between the components and withremote systems such as central caregivers and emergency services, and toprovide care to the subject 202 or provide instructions to caregivers,such as caregiver 238, in providing care to the subject 202.

The subject 202 is positioned to receive therapy from the caregiver 238with the assistance of a Main Processing Unit (MPU) 212. For example, aset of defibrillator electrodes 210 has been applied to the subject'storso in a typical manner and is in wired connection to a portableexternal defibrillator 208 in the MPU 212. The defibrillator 208 may be,for example, a typical automated external defibrillator (AED), aprofessional defibrillator, or another similar type of defibrillatingapparatus. A ventilation bag provides forced air into the subject'slungs to assist in rescue breathing for the subject. The defibrillator208 and ventilation bag may be operated in familiar manners and incoordination by one or more caregivers. The ventilation bag may befitted with various sensors and transmitters so as to collect data andto communicate electronically with the defibrillator 208. For example, avolumetric flow sensor provided with the ventilation bag may collectdata about the volume of airflow to and from the subject, which data istransmitted to the defibrillator 208. The defibrillator 208 may relaythese data, e.g., to the caregiver 238 and/or to the emergency responsecenter 206; and/or may use the data to affect the manner in whichdefibrillation is provided to the subject 202.

A computer tablet 214 is provided in communication with the otherdevices of the system 200 and can be manipulated by the caregiver 238.The tablet 214 may serve as a general electronic command post for thecaregiver 238 to receive information, e.g., about the subject 202, tocommunicate with other caregivers, and to provide input for controllingthe operation of the components of the system 200. The tablet 214 may beprovided with short range and/or long range wireless communicationcapabilities, such as Bluetooth, Wi-Fi, and/or cellular 3G or 4Gcapabilities. The tablet 214 may also be in data communication withsensors that sense real-time information about the subject 202, such asthe subject's blood pressure, pulse, or other real-time subjectmonitoring data (discussed in more detail below). The caregiver 238 mayinput information into the tablet 214, such as information describingthe condition of the subject 202 or other information that is to berecognized and recorded by the caregiver 238. The caregiver may alsoinput information into tablet 214 so as to control one or more of themedical devices being used with the subject 202. For example, thecaregiver may adjust the type, intensity, speed, or coordination oftreatment that is provided to the subject 202.

The MPU 212 includes a communication module 237, which includes atransmitter and a receiver for providing a communication link betweenthe MPU 212 and the emergency response center 206. The communicationmodule 237 may include short range and/or long range wirelesscommunication capabilities, such as Bluetooth, Wi-Fi, and/or cellular 3Gor 4G capabilities. During operation, the communication module 237 sendsa signal to a cellular tower 241, which in turn relays the signal to theemergency response center 206, thus establishing communication betweenthe MPU 212 and the emergency response center 206. While shown in FIG. 2as being included in the MPU 212, the communication module 237 couldadditionally or alternatively be included in the tablet 214.

Communication module 237 may enable the caregiver 238 to talk with aresponder at the emergency response center 206, for instance to shareinformation about the status of the subject 202, to requestinstructions, or to request assistance. Similarly, the responder may,for instance, provide instructions or support to the caregiver 238 orask questions of the caregiver. In some cases, the communications moduletransmits some or all of the real-time patient monitoring data sensed byany of various sensors to the emergency response center 206 for viewingand/or analysis.

A video module 240 controls the operation of one or more cameras 204,which are positioned to acquire still and/or video images of the subject202. For instance, one camera may be attached to the defibrillator 208such that when the defibrillator is in operation, the camera is able toacquire an image of the subject. Another camera may be attached to aheadpiece to be worn by the caregiver 238 so as to provide a close-upimage of the subject 202 as the subject undergoes treatment. The videosacquired by one or more of the cameras may be sent to the emergencyresponse center by the communications module. In some embodiments, astill image acquired by each of the cameras 204 is sent to the emergencyresponse center so that a responder (e.g., a dispatcher, firstresponder, or other professional) can select the camera that presents adesired image. Once the responder selects a camera, video acquired bythe selected camera is streamed to the emergency services center via thecommunications module.

In some cases, both subject data and video may be sent to the emergencyresponse center. Depending on the communication link between thecommunication module and the emergency response center, there may not besufficient bandwidth to support transmission of both subject data andvideo and/or audio. In this case, the video and/or transmission may betemporarily halted to allow for preferential transmission of the subjectdata to the emergency response center. Alternatively, the video may betransmitted at a lower frame rate than the frame rate at which the videowas acquired by the camera (e.g., a ratio of the frame rate of theacquired video to the transmitted video can be at least 2:1, at least3:1, or at least 4:1).

One or more sensors, such as sensors applied to the subject 202, provideinput signals to MPU 212 that characterize the current real-timecondition or physical parameters of the subject 202. The signals may beused by the MPU 212 to determine an appropriate treatment for thesubject 202, such as a timing and/or force for chest compressions 218delivered to the subject. For example, an ECG signal 222, obtained fromleads connected to defibrillator 208, may represent the current andreal-time ECG waveforms for the subject 202. An SpO₂ (oxygen saturation)signal 223 or another physiologically derived signal that is a direct orindirect measure of circulatory flow or perfusion, is obtained from acorresponding sensor. Other input signals may include physiologicalsignals such as measures of cardiac output, measures of heart rate,blood pressure(s), ECG, oxygen saturation (SpO₂), heart sounds (e.g.,phonocardiography), heart imaging (e.g., ultrasound), and/or impedancecardiography.

A signal processing unit 228 in the MPU 212 filters inputs, such as ECGinputs, for further analysis by a microprocessor 230. For example, thesignal processing unit 228 may filter noise from input signals. In thecase of ECG data, the signal processing unit 228 may filter artifactscreated by chest compression motion 226 of the subject 202 in order toremove such artifacts. Such preparation of ECG signals may be termedSEE-THRU CPR®, and can be performed as discussed in U.S. Pat. No.7,220,235, the contents of which are incorporated herein by reference intheir entirety.

The microprocessor 230 receives input information associated with thereal-time parameters of the subject 202, including ECG waveform data.The microprocessor 230 also performs analysis on such data to determinewhether defibrillation is needed and/or to modify the feedback promptsprovided by the display 224 and/or a speaker 236 a controlled by anaudio processing unit 236 b.

Based on either retrospective data analysis of clinical datasets thatinclude simultaneous recording of sternal motion signals and ECGs aswell as patient outcome data, or of pre-clinical testing in animalmodels, a statistical model may have been developed that can predict therisk of fibrillation induction. The statistical model may in turn beused to determine an appropriate compression profile to be provided to apatient, and to be aligned in time with ECG data of the patient. Thestatistical model may be in the form of either a linear or non-linearregression equation, using such techniques as multiple logisticregression, for example.

The chest compression actions and/or other actions undertaken withrespect to the subject 202 may be performed manually and may be promptedby various devices, including the MPU 212. Changes in compressionprofile may also be prompted via a manual process. For example,coordinated chest compression times and rates may be computed by themicroprocessor 230 and verbally announced by the speaker 236 a. Forexample, a metronome of beeping sounds may be played during CPR toindicate to the caregiver 238 when to press down on the subject's chestso as to avoid compressions or decompressions during a vulnerableperiod. Furthermore, the display 224 may provide coordinated visualfeedback, such as a display of an ECG waveform, a graph of compressiondepth, or other similar data that may be helpful to the caregiver inproviding care to the subject 202.

Referring to FIG. 3, in an example process for camera selection, an AEDis associated with multiple video cameras. The cameras may be positionedto acquire still images and/or video images of various portions of therescue scene, such as broad view of much of the rescue scene, an imageof the subject, an image of the caregiver's treatment of the subject, oranother view. For instance, a camera may be mounted on a headpiece orother wearable item that is to be worn by the caregiver, e.g., toprovide a view of the caregiver's treatment of the subject. Anothercamera may be mounted on the AED, e.g., to provide a broad view of alarge part of the rescue scene. Additional cameras may also be providedfor positioning in other locations. For instance, a mobile (e.g.,handheld) camera may be provided that can be held and operated byanother caregiver or a bystander.

When a subject needs assistance (e.g., the subject appears to beexperiencing sudden cardiac arrest), a caregiver initializes an AED(step 300). The cameras associated with the AED are also initialized(step 302). In some examples, the cameras are initialized automaticallyupon initialization of the AED. In other examples, one or more of thecameras are initialized manually, for example, when the caregiver turnson the camera or puts on a headpiece on which the camera is mounted. Oneor more of the cameras may be in a position to acquire a video image ofthe subject.

The subject is monitored (step 304) by one or more sensors duringtreatment, as discussed above, and real-time subject monitoring data iscollected. For instance, signals such as an ECG waveform, an SpO₂ level,a blood pressure, a measure of cardiac output, or a measure of heartrate may be monitored. Alternatively or additionally, compressionparameters may be monitored. Compression parameters may include, forinstance, a sternal motion signal, compression velocity; compressiondepth; duty cycle; velocity of down stroke and/or upstroke;introthoracic pressure(s) during compressions; pleural pressure(s)during compressions; sternal position, velocity, and/or acceleration;chest wall or sternal strain or deformation; force applied to the chest;and/or pressure used to compress the chest by a mechanical chestcompressor.

A video and data transmission channel is established (step 306) betweenthe AED system and the emergency response center. For instance, thetransmission channel may be a long-range wireless communication channel,such as a cellular 3G or 4G channel; or the transmission channel may bea short-range wireless communication channel, such as a Bluetooth orWi-Fi connection, that is connected to a hardwired communicationchannel.

A still image from each of the cameras is transmitted to the emergencyresponse center (step 308) and displayed to a responder, e.g., on adisplay interface such as a computer monitor, television screen, mobilecommunications device, or other display interface. The responder isprompted to select one of the images. For instance, the responder mayselect the image that provides a view of the subject, a view of a largepart of the rescue scene, a view of the caregiver's treatment of thesubject, or another view.

The responder's selection is transmitted via the transmission channeland received by the AED system (step 310). Video from the cameraassociated with the selected image is transmitted to the emergencyresponse center (step 312).

The video from the selected camera may be transmitted along with thesubject monitoring data. In some embodiments, a listing of some or allof the available types of subject monitoring data is also presented tothe responder on the display interface such that the responder mayselect one or more types of data for transmission. For instance, an ECGwaveform, an SpO₂ level, a compression rate, and a compression depth maybe available, from which the responder is prompted to select one or morefor transmission. In some cases, the transmission of video and subjectmonitoring data may be controlled based on the available bandwidth ofthe communication channel, as described in greater detail below.

Referring to FIG. 4, an example user interface 400 displayed on adisplay interface at the emergency response center allows a responder atthe emergency response center to select an image corresponding to adesired camera view and which types of subject monitoring data to betransmitted.

In the illustrated example, a camera selection window 402 displaysimages 404 and 406 corresponding to cameras A and B, respectively. Ascan be seen from image 404, camera A is positioned to provide a view ofa subject 408. As can be seen from image 406, camera B is positioned toprovide a view of a caregiver 410 treating subject 408. The responderselects the image corresponding to the camera from which he would liketo view video by selecting (e.g., clicking on) the appropriate selectionbutton 412 a, 412 b.

The user interface 400 also includes a data selection window 414 thatallows the responder to select one or more types of subject monitoringdata to be transmitted. In the illustrated example, an ECG waveform,compression rate and depth data, and SpO₂ data are available fortransmission. The responder selects one or more of the types of datathat he would like to receive by selecting (e.g., clicking on) one ormore of the appropriate selection buttons 416 a, 416 b, 416 c, 416 d.

The responder's image and data selections are transmitted back to theAED system at the rescue scene. Video from the camera corresponding tothe selected image is streamed to the emergency response center. Inaddition, the selected type(s) of data are transmitted to the emergencyresponse center. In some embodiments, the transmission of video andsubject monitoring data may be controlled based on the availablebandwidth of the communication channel, as discussed below.

In an alternative embodiment, video from all of the cameras is initiallydisplayed on the user interface, and the responder is given the optionto select one or more cameras for which to cease video transmission.

In another alternative embodiment, the user interface is provided at therescue scene, e.g., on the tablet computer or another screen associatedwith the AED. The rescuer selects one or more cameras and/or types ofsubject monitoring data to be transmitted to the emergency responsecenter.

Referring to FIG. 5, in an example process, an AED provides thecapability to control the transmission of subject monitoring data and/orvideo to the emergency response center based on the available bandwidthof the transmission channel.

When a subject needs assistance (e.g., the subject appears to beexperiencing sudden cardiac arrest), a caregiver initializes an AED(step 500). One or more cameras associated with the AED are alsoinitialized (step 502). In some examples, the cameras are initializedautomatically upon initialization of the AED. In other examples, thecameras are initialized manually, for example, when the caregiver turnson a camera or puts on a headpiece on which a camera is mounted. Thecameras may be in a position to acquire a video image of the subject. Insome examples, one or more cameras previously selected by a responder atthe emergency response center (e.g., as described above) areinitialized.

The subject is monitored (step 504) by one or more sensors duringtreatment, as discussed above, and real-time subject monitoring data iscollected. For instance, signals such as an ECG waveform, a SpO₂ level,a blood pressure, a measure of cardiac output, or a measure of heartrate may be monitored. Alternatively or additionally, compressionparameters, such as a sternal motion signal or another measurement ofcompression, may be monitored.

A video and data transmission channel is established (step 506) betweenthe AED system and the emergency response center. For instance, thetransmission channel may be a long-range wireless communication channel,such as a cellular 3G or 4G channel; or the transmission channel may bea short-range wireless communication channel, such as a Bluetooth orWi-Fi connection, that is connected to a hardwired communicationchannel.

The available bandwidth on the transmission channel is monitored (step508) and a determination is made as to whether the available bandwidthis below a predetermined threshold (step 510). The threshold may bedetermined, for instance, based on an expected quantity of data to besent via the transmission channel and/or a desired data transmissionspeed. In some examples, the threshold may be, e.g., 750 kbps, 1 Mbps,1.5 Mbps, or another threshold.

If the available bandwidth is above the threshold, then the subjectmonitoring data and the video are both transmitted to the emergencyresponse center via the transmission channel (step 512). If, however,the available bandwidth is below the threshold, the subject monitoringdata may be preferentially transmitted to the emergency response centerwhile the video is not transmitted (step 514). Alternatively, thesubject monitoring data and the video may both be transmitted, but withthe video at a lower frame rate than the frame rate at which the videowas originally acquired (step 514). For instance, a ratio of the framerate of the acquired video to the frame rate of the transmitted videomay be at least 2:1, at least 3:1, or at least 4:1. In some embodiments,audio data may also be preferentially transmitted, e.g., when theavailable bandwidth is above a threshold for data-only transmission butbelow a threshold for full transmission of data, audio, and video.

The available bandwidth is monitored during the transmission of dataand/or video to the emergency response center and adjustments are madeas appropriate. For instance, if the bandwidth of the channel suddenlyfalls below the threshold, the video transmission may be stopped or theframe rate of the transmitted video may be reduced. Alternatively, ifthe bandwidth of the channel had been below the threshold but risesabove the threshold, transmission of the video may be started.

The features described can be implemented in digital electroniccircuitry, or in computer hardware, firmware, software, or incombinations of them. The apparatus can be implemented in a computerprogram product tangibly embodied in an information carrier, e.g., in amachine-readable storage device, for execution by a programmableprocessor; and method steps can be performed by a programmable processorexecuting a program of instructions to perform functions of thedescribed implementations by operating on input data and generatingoutput. The described features can be implemented advantageously in oneor more computer programs that are executable on a programmable systemincluding at least one programmable processor coupled to receive dataand instructions from, and to transmit data and instructions to, a datastorage system, at least one input device, and at least one outputdevice. A computer program is a set of instructions that can be used,directly or indirectly, in a computer to perform a certain activity orbring about a certain result. A computer program can be written in anyform of programming language, including compiled or interpretedlanguages, and it can be deployed in any form, including as astand-alone program or as a module, component, subroutine, or other unitsuitable for use in a computing environment.

Suitable processors for the execution of a program of instructionsinclude, by way of example, both general and special purposemicroprocessors, and the sole processor or one of multiple processors ofany kind of computer. Generally, a processor will receive instructionsand data from a read-only memory or a random access memory or both. Theessential elements of a computer are a processor for executinginstructions and one or more memories for storing instructions and data.Generally, a computer will also include, or be operatively coupled tocommunicate with, one or more mass storage devices for storing datafiles; such devices include magnetic disks, such as internal hard disksand removable disks; magneto-optical disks; and optical disks. Storagedevices suitable for tangibly embodying computer program instructionsand data include all forms of non-volatile memory, including by way ofexample semiconductor memory devices, such as EPROM, EEPROM, and flashmemory devices; magnetic disks such as internal hard disks and removabledisks; magneto-optical disks; and CD-ROM and DVD-ROM disks. Theprocessor and the memory can be supplemented by, or incorporated in,ASICs (application-specific integrated circuits).

To provide for interaction with a user, the features can be implementedon a computer having a display device such as a CRT (cathode ray tube)or LCD (liquid crystal display) monitor for displaying information tothe user and a keyboard and a pointing device such as a mouse or atrackball by which the user can provide input to the computer.

The features can be implemented in a computer system that includes aback-end component, such as a data server, or that includes a middlewarecomponent, such as an application server or an Internet server, or thatincludes a front-end component, such as a client computer having agraphical user interface or an Internet browser, or any combination ofthem. The components of the system can be connected by any form ormedium of digital data communication such as a communication network.Examples of communication networks include, e.g., a LAN, a WAN, and thecomputers and networks forming the Internet.

The computer system can include clients and servers. A client and serverare generally remote from each other and typically interact through anetwork, such as the described one. The relationship of client andserver arises by virtue of computer programs running on the respectivecomputers and having a client-server relationship to each other.

The computer system may include software for implementing an electronicpatient care record, for example the ePCR software of ZOLL Data Systems(Broomfield CO). The software provides the ability to enter, store andtransmit patient information as well as therapeutic interactions. Thecomputer is often a so-called “tablet” computer system that has beenruggedized for pre-hospital use, but may also take the form of an IPHONEor IPAD. Data is preferably transmitted in real time between theportable “tablet” computer to an MPU 212, such as data that indicatesthe delivery of epinephrine to a subject. As epinephrine may increaserisk of VF induction, notification of its delivery may be used by theMPU to adjust the compression parameters to further minimize risk of VFinduction. Other separate treatments provided to the patient, orparameters of the patient condition sensed by the various sensors mayalso be provided to the tablet, and may factor into the rate, timing,force, or speed with which compressions and decompressions are performedon the patient.

A number of embodiments have been described. Nevertheless, it will beunderstood that various modifications may be made without departing fromthe spirit and scope of the invention. Accordingly, other embodimentsare within the scope of the following claims.

1. A defibrillator system comprising: an external defibrillator; a chestcompression sensor communicatively coupled to the external defibrillatorand configured to generate signals indicative of chest compressionparameter data for chest compressions provided to a medical rescuesubject one or more video cameras communicatively coupled to theexternal defibrillator and configured to acquire at least one video ofthe medical rescue subject, communications circuitry comprising atransmitter and a receiver together configured to establish abi-directional communication channel between the defibrillator systemand an emergency response center, and processing circuitrycommunicatively coupled to the communications circuitry, the processingcircuitry comprising one or more processors configured to: receive thesignals indicative of the chest compression parameter data from thechest compression sensor, receive the at least one video from the one ormore video cameras, evaluate an available bandwidth of thebi-directional communication channel, control transmission to theemergency response center of the at least one video and the chestcompression parameter data, based on the available bandwidth of thebi-directional communication channel, wherein the transmission is viathe transmitter.
 2. The defibrillator system of claim 1 wherein one ormore of the communications circuitry and the processing circuitry aredisposed in the external defibrillator.
 3. The defibrillator system ofclaim 1 comprising a mobile computing device communicatively coupled tothe external defibrillator.
 4. The defibrillator system of claim 3wherein one or more of the communications circuitry and the processingcircuitry are disposed in the mobile computing device.
 5. Thedefibrillator system of claim 3 wherein the mobile computing device isone of a tablet computing device or a mobile communications device. 6.The defibrillator system of claim 1 wherein the one or more processorsare configured to evaluate whether the available bandwidth of thebi-directional communication channel is below a threshold that ispre-determined based on an expected quantity of subject monitoring data.7. The defibrillator system of claim 6 wherein the one or moreprocessors are configured to preferentially transmit the subjectmonitoring data if the available bandwidth of the bi-directionalcommunication channel is below the threshold that is pre-determinedbased on the expected quantity of subject monitoring data.
 8. Thedefibrillator system of claim 1 comprising one or more medical sensorscommunicatively coupled to the one or more processors and configured tosend medical sensor data to the one or more processors.
 9. Thedefibrillator system of claim 8 wherein the one or more processors areconfigured to: receive the medical sensor data, send, via thetransmitter, to the emergency response center, a list of types ofmedical sensor data available in the received medical sensor data;receive, via the receiver, from the emergency response center, selectedtypes of medical sensor data from the list of the types of medicalsensor data available in the received medical sensor data; and controltransmission, via the transmitter, to the emergency response center, ofthe selected types of medical sensor data based on the availablebandwidth of the bi-directional communication channel.
 10. Thedefibrillator system of claim 9 wherein the types of medical sensor datacomprise one or more of electrocardiogram (ECG) data, oxygen saturationdata, cardiac output data, heart rate data, heart sound data, heartimaging data, and impedance cardiography data.
 11. The defibrillatorsystem of claim 1 comprising a microphone configured to detect audio ata site of the medical rescue subject and comprising speakers configuredto audibly provide audio information transmitted from the emergencyresponse center and received at the receiver.
 12. The defibrillatorsystem of claim 11 wherein the one or more processors are configured to,based on the available bandwidth of the bi-directional communicationchannel, control transmission, via the transmitter, of the detectedaudio to the emergency response center to preferentially allow receptionthe audio information transmitted from the emergency response center.13. The defibrillator system of claim 11 wherein the audio informationcomprises cardiopulmonary resuscitation (CPR) instructions.
 14. Thedefibrillator system of claim 11 wherein the audio information comprisesone or more of instructions as to how to open electrode packaging,instructions as to how to place electrodes on the medical rescuesubject, and instructions as to how to place one or more medical sensorson the medical rescue subject and the one or more processors areconfigured to control the speakers to audibly provide the one or more ofthe instructions as to how to open electrode packaging, the instructionsas to how to place electrodes on the medical rescue subject, and theinstructions as to how to place the one or more medical sensors on themedical rescue subject.
 15. The defibrillator system of claim 11comprising a mobile computing device communicatively coupled to theexternal defibrillator wherein the microphone and the speakers aredisposed in the mobile computing device.
 16. The defibrillator system ofclaim 11 wherein the microphone and the speakers are disposed in theexternal defibrillator.
 17. The defibrillator system of claim 1comprising a ventilation device communicatively coupled to the externaldefibrillator wherein the one or more processors are configured tocontrol transmission of ventilation data, received from the ventilationdevice, to the emergency response center based on the availablebandwidth of the bi-directional communication channel.
 18. Thedefibrillator system of claim 1 wherein the communications circuitry isconfigured to provide one or more of short range wireless communicationsand long range wireless communications.
 19. The defibrillator system ofclaim 1 wherein the chest compression parameter data comprises data forone or more of sternal motion, compression velocity, compression depth,duty cycle, downstroke velocity, upstroke velocity, intrathoracicpressure, pleural pressure, sternal position, sternal velocity, sternalacceleration, sternal strain, sternal deformation, compression force,and compression pressure.
 20. The defibrillator system of claim 1comprising a mechanical chest compression device wherein the chestcompression parameter data is associated with chest compressionsdelivered to the medical rescue subject by the mechanical chestcompression device.